Grey’s Anatomy (Season 13, Episode 9). A building collapses when a landlord has failed to make necessary repairs a year after an earthquake. The landlord mistakes a resident for a priest and confesses that his neglect was the cause of the tragedy that has led to much morbidity and mortality. The resident wonders if he has to preserve confidentiality like a priest or if information told to a doctor is different. A fellow resident tells him that since it’s not medically related, he has no obligation to maintain this particular confidence.…

This new TV show might be the ethicists worst nightmare. The show opens with Dr. Mulroney at a hearing where he admits to giving a patient an unapproved FDA drug to a patient who died. He is dismissed. The point of this opening scene is to present medicine as too conservative, too stodgy, and not willing to take risks for innovation.

The second presents a case takes in an Oakland, CA hospital where a 15-year-old girls is unresponsive in a “coma” for some unknown reason.…

An occasional column examining the ethical issues raised in television medical dramas.

On Code Black (Season 2; Episode 3) the most important ethical issue was very brief, not taking more than about 2 minutes of screen time. Dr. Angus Leighton is a resident whose brother is unconscious and connected to life supporting technology after falling out of a helicopter (it is a drama after all). Angus is the named medical power of attorney. However, his father has had his attorney draw up papers that transferred the power of attorney from Angus to the father.…

A government agency recruits elderly and sick patients for an important research study. In a controlled environment, subjects are exposed to airborne pollutants at levels many times higher than found in the real world. Some pollutants are considered so dangerous that the FDA considers any exposure to be dangerous.

Such a scenario may sound like a historical case study of human subjects abuse, but such studies are actually the subject of an 18-month review by the EPA on ethical conduct of research.…

Our favorite television dramas this week were light on bioethics issues with the exception of Chicago Med (season 1; episode 17 “Withdrawal”) that continues to explore bioethical issues. This week the theme was arrogant paternalism—residents and fellows believing that only they know what is in the best interest of the patient.

The first storyline concerns a patient brought into the ED in the throes of alcohol withdrawal. He is a frequent flyer patient and has not had a drink in 2 days.…

Euthanasia is when a physician delivers the substance that ends a patient’s life. This is distinct from physician/doctor/provider-assisted suicide (often called aid-in-dying) where a physician makes the means to end life available (often through a prescription) but the patient must ingest the life-ending medication.…

This new show is always good for presenting challenges in professionalism and bioethics. This week (season 1; episode 16) is no exception as the fictional hospital finds itself in the middle of a surprise Joint Commission visit (though they often refer to the organization as “jay-koh” it’s previous abbreviation). One of the storyline this week deals with a retired neurologist and her husband with Lewy Body syndrome.…

Two years after John Donne’s death, the Holy Sonnets were published. In Sonnet 10, Donne speaks about the end of death: “Death, thou shalt die.” Although a metaphorical conceit referring to eternal life in heaven, the poem takes on new meaning in the age of regenerative medicine.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.…

Ethel Easter expressed outraged this week at what her health care team said about her during her surgery in Texas last year. She claims that before her operation she was flagged as a difficult patient and instead of talking to her doctors at that time, she hid a recording device in her hair. Listening to the recording after her operation, she heard the medical staff discussing her as a “handful” and making other disparaging comments.

This case comes after “D.B.” in 2013 accidentally left his cell phone in record mode during a procedure.…

BioethicsTV is an occasional bioethics.net feature where we examine bioethical issues raised in televised medical dramas.

Tonight marked the mid-season premiere of Chicago Med, a freshman television show that seems to relish throwing professional and bioethical issues at its audience. This week, viewers saw no fewer than 4 ethical challenges.

1. Blood draws for DUI in the ED. The first story was about a young man who crashes his car into a house. He is brought to the ED and needs immediate surgery for internal bleeding.…

In teaching research ethics, there are a few “classic cases” that we offer students as examples of where human subject research went wrong: Tuskegee Study of Untreated Syphilis, the Nazi medical experiments, Willowbrook Hepatitis Experiments, human radiation experiments, and (now) the Guatemala syphilis study, among others. When discussing social science examples, the two studies that are usually taught at Milgram’s obedience studies and Zimbardo’s Stanford Prison Experiment.

As an undergraduate at Stanford, my Psychology 101 teacher was Philip Zimbardo.…

Before you being reading, I have a disclaimer: Growing up, my mother worked for Planned Parenthood. As a nurse, she practiced in their clinics offering well women services, counseling, and contraception. After many years, she went on to direct their clinic’s in vitro fertilization program. I also heard the word “Planned Parenthood” stated with a quick northeastern accent. Said that way, as a child, I thought the place was called “Plant Parenthood” and wondered what plants had to do with women’s health.…

Philosopher Tamar Gendler has introduced (circa 2008) a new concept in the philosophical literature that could be of interest to medical ethicists. The concept is that of ‘alief’ and it is meant to contrast with the concept of ‘belief.’ An example Gendler discusses to tease out the difference between the two concepts is the example of a woman who believes African American and Caucasian people to be of equal intelligence, yet in her behavioral responses it seems as if she believes differently (e.g., she is more surprised when an African American student of hers makes an intelligent comment than she is when a Caucasian student does, she more quickly associates intelligence with her Caucasian students, when grading exams she might grade the same quality exam differently if written by an African American student than a Caucasian student, etc.).…

]]>Research 2.0: Rise of the Citizen-Scientist and the Death of Privacyhttp://www.bioethics.net/2015/03/research-2-0-rise-of-the-citizen-scientist-and-the-death-of-privacy/
Thu, 26 Mar 2015 07:34:05 +0000http://www.bioethics.net/?p=54466by Craig Klugman, Ph.D.

On Monday I attended a symposium on inter-professional education. During a session on new technologies in medicine (telemedicine, wearables, and mobile devices) I brought up the question of preserving privacy. The foundation sponsoring the event replied to me, “There is no such thing as privacy. It’s dead.” For someone who works in bioethics, serves on an IRB, and was formerly a journalist, this notion is scary. Perhaps, I have simply been in denial. After all, I use a mobile phone that tracks my position, synchs with the cloud, and provides much convenience.…

In the 1979 novel Sophie’s Choice by William Styron, the reader meets a Holocaust survivor who was forced in the camps to choose which of her two children would die immediately. Making the choice led to a life of alcoholism, depression, and self-destructive behavior. One interpretation of this novel, later made into an Academy Award winning film (1982), is that having choose whether a loved one lives or dies is a spirit-wrenching decision.

And yet, everyday, health care providers and bioethicists ask legally appointed health care power of attorneys and other designated surrogates to decide whether an incapacitated patient has surgery, receives a feeding tube, is resuscitated, or is intubated.…

A few months ago Facebook announced that some Facebook users were a part of a 2012 experiment. In the experiment Facebook altered the number of negative and positive posts and photos that appeared in users’ newsfeed. In a paper documenting the results of the study, authors noted that by changing what users saw in their feed, Facebook was able to alter moods, emotions, and the kind of posts that people posted. The study was meant to be an experiment in online social interactions and emotional connections.…

]]>﻿AIN’T JUST THE MEAT IT IS ALSO THE MOTION: CONSENT MATTERS!http://www.bioethics.net/2014/07/%ef%bb%bfaint-just-the-meat-it-is-also-the-motion-consent-matters/
Tue, 29 Jul 2014 17:18:43 +0000http://www.bioethics.net/?p=52141“But look, you found the notice, didn’t you?”

“Yes,” said Arthur. “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.'”

–Douglas Adams, The Hitchhiker’s Guide to the Galaxy

Any apologia for Facebook’s recent behavioral study has to address one issue head on: that of informed consent. Informed consent is the bedrock upon which the ethics of all biomedical and behavioral research on humans rests.…

PART 1: SCOTUSOne of the facts that hiring managers are taught is that you can never ask a potential employee about their religion (among other protected areas) unless the candidate brings it up. But after this week, any job candidate would be wise to ask their potential employer about his/her/its (in the case of corporations) religious beliefs.

Who one works for is increasingly determining not only what health care coverage you have but also what laws you have to follow and what legal protections you have.…

A New York Times article published this week describes a clinical trial in Pittsburgh where incapacitated and rapidly exsanguinating gunshot victims have their blood replaced by cold saline for up to an hour in an effort to preserve neurological function and life. This trial has raised many ethical concerns, one of which is whether the community consultation conducted before and during the trial (which is required by federal guidelines) was adequate enough to inform the community about the opt-out trial and to collect extensive feedback from it.…

When an article promoting the idea of medical futility appeared in the Annals of Internal Medicine in 1990, my father was thrilled. He believed the term was an apt description of the end-stage cases he too often saw as an infectious diseases consultant, in which he was expected to prescribe progressively more complicated antibiotic regimens to severely ill patients with no hope of recovery.

The concept of medical futility has achieved mixed success. Advocates have promoted it as a way to discourage aggressive treatment of medical conditions that are not reversible. …

For many people, the film Philomena was an introduction to a history of Irish babies being taken from their unwed mothers and adopted to “good” Catholic families in other countries. I put “good” in quotes because often what qualified a couple was the ability to pay. In the last week, news has come out of Ireland of a mass grave holding the remains of 796 infants buried in a septic tank on the grounds of a former “mother and baby” home in Galway.…

There has been a great deal of fingerpointing, second-guessing and recrimination over the decision by the President to exchange five former Taliban leaders for the American soldier, Bowe Bergdahl. “You’ve just released five extremely dangerous people, who in my opinion … will rejoin the battlefield,” Senator Marco Rubio, R-Fla., and likely Presidential candidate told Fox News. Senator John McCain, R-AZ, told ABC news and many other outlets that he would never have supported the swap if he’d known exactly which prisoners would be exchanged given their former high roles in battling the U.S.…

In a few days, the Journal of Clinical Ethics will publish my seventeenth “Legal Briefing” column. Each column reviews recent legal developments involving a particular issue in clinical bioethics. I have covered topics from organ donation and medical futility, to home birth and conscience clauses. This one, in 25(2):152-174, is titled “Informed Consent in the Clinical Context.”